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DOULOS ENVIRONMENTAL COMPANY SAMPLING INFORMATION SHEET <br /> Client:- Sampling Date: <br />. Site: Project No. : <br /> Well Designation: w '�- <br /> Is setup of traffic control devices required? YES time: hours <br /> Is there standing water in well box? YES Above TOC Below TOC <br /> Is top of casing cut level? If no, see remarks <br /> Is well cap sealed and locked? 4 YES If no, see remarks <br /> Height of well casing riser (in inches) : <br /> Well cover type: 8" " U <br /> UV 12V 12" EMCO 8" BK <br /> 12" BK 12" DWP 12" CNI 36" CNI Other <br /> General condition of wellhead assembly: Excellent Loll Fair Poor <br /> Purging Equipment: 2" disposable bailer Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer _,,Centrifugal pump <br /> Sampled with: Disposable bailer Teflon bailer: <br /> Well Diameter: 2" 4" 6" 8" <br /> Purge Vol. Multiplier: 0. 16 0. 65 1.47 2 . 61 gal/ft. <br /> ,Initial -Measurement Recharge Measurement <br /> Time: 1 � Time: �- Calculated purge:-L:�— <br /> Depth of well: Depth to water: ?�,00 _ Actual purger <br /> Depth to water: <br /> Start purge: 7 Sampling time: <br /> Time Temp. E.C. pH Turbidity Volume <br /> 11- r <br /> 71, 1306 )-' <br /> 2 L <br /> Sample appearance: -- Lock: �n ' <br /> Equipment replaced: (Check all that apply) Note condition of replaced item <br /> 2" Locking Cap: Lock #3753 : 7/32 Allenhead:_ <br /> 4" Locking ap:�,.l�. Lock-Dolphin:�� 9/16 Bolt: <br /> 6" Locking Cap: Pinned Allenhead (DWP) : <br /> Remarks: <br /> I9 � 6 <br /> Signature: ` ' — 4 <br />